Addressing Climate Adaptation in California’s Public Health System

Kathryn Braddock
Kathryn Braddock, Dorette Quintana English, and Ariadne Villegas
Posted on: 12/11/2020 - Updated on: 12/18/2020

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Kathryn Braddock

Project Summary

Agencies and organizations in California are undertaking a wide variety of efforts to address public health concerns related to climate change. As part of the Safeguarding California adaptation plan, the state health department developed an implementation plan for the public health sector, detailing efforts underway such as the development of tools to improve decision-making (e.g., Urban Heat Island Index) and the California Building Resilience Against Climate Effects (CalBRACE) program. CalBRACE has developed county-level climate and health profiles, vulnerability indicators, and an Adaptation Planning Toolkit. Tribes such as the Blue Lake Rancheria and the Pala Band of Mission Indians are working to reduce air and water pollution and improve emergency response capabilities, while local health departments are educating the public and practitioners on the links between public health and climate change. Other key resources include websites, such as Tracking California, the state Adaptation Clearinghouse, and Cal-Adapt, which provide data and tools to support climate-informed decision-making.


California faces climate impacts such as extreme heat, drought, wildfires, sea level rise, and severe weather events. These changes can lead to grave public health concerns such as degraded water quality, respiratory and heat-related illnesses,  and vector-, water-, and food-borne diseases. Fires and droughts in Los Angeles and the Bay Area are causing increasing health problems along with forced displacement of individuals, households, and communities, exacerbated by various socioeconomic inequities. In January 2019, over 30 health organizations in California banded together in a Call to Action sent to Governor Gavin Newsom and other key California legislators. The Call to Action recognizes climate change as a public health emergency and focuses on the need to act on climate, health, and equity concerns. Among the endorsing organizations are the California Black Health Network, California Conference of Local Health Officers, Central California Asthma Collaborative, Climate Psychiatry Alliance, Health Officers Association of California, Medical Society Consortium on Climate and Health, Public Health Institute, Roots of Change, and Service Employees International Union.


State Climate and Health Adaptation Efforts

In response to Executive Order B-30-15 on greenhouse gas emissions reductions,  various state agencies updated the state climate adaptation plan and developed implementation plans for different sectors (e.g., health, agriculture, emergency management, energy). The California Department of Public Health (CDPH) developed the public health sector plan around three priorities: 

  1. Improving capacity of communities to prepare, respond, and recover from climate-related health risks;
  2. Increasing understanding of climate impacts on public health; and
  3. Promoting information sharing and education.

The plan provides details on a vulnerability assessment, current actions, a series of topic profiles (i.e. climate justice, emergency management, energy, land use and community development, public health, transportation, agriculture, biodiversity and habitat, forests, water, ocean and coast) and future recommendations for California regarding health and climate impacts. The plan highlights priority initiatives underway in the state including the Integrated Transport and Health Impacts Model (ITHIM), urban heat island mitigation measures, and the California Building Resilience Against Climate Effects (CalBRACE) program. The ITHIMis a tool that estimates potential health co-benefits and harms from different transportation scenarios in urban centers (e.g., in San Francisco, walking and biking reduce cardiovascular disease risks by 14% and decrease greenhouse gas emissions by 14%). The tool is being used to inform land-use planning and transit decisions that support public health and reduce emissions.

Urban heat islands, which contribute to heat-related illnesses, are addressed through initiatives such as the installation of cool pavements by the California Energy Commission. The development of green and energy efficient buildings, understanding the impacts of climate change on public health, and information sharing and education initiatives are detailed further in the Action Plan. The plan notes that there is no centralized process for monitoring and evaluation of recommended or ongoing projects. 

The California Building Resilience Against Climate Effects (CalBRACE) initiative is part of the Centers for Diseases Control’s (CDC) Climate-Ready States and Cities Initiative and functions as an initiative of the CDPH in collaboration with local health departments throughout the state. The project followed the CDC’s BRACE five-step framework, focusing on increasing temperatures/extreme heat, wildfire, and sea level rise (including flooding). The program has developed an Adaptation Planning Toolkit, which is a collection of tools, guides, reports, and other resources to assist decision makers in developing and implementing adaptation strategies. The CalBRACE initiative has also released a series of case studies detailing public health impacts due to climate change and related efforts in local health departments across the state (e.g., Los AngelesMariposaSan DiegoSan Luis Obispo, and Santa Clara). For example, the Los Angeles County Public Health Department created a working group to develop a department-wide adaptation plan. One of the outcomes was a partnership with the University of California Los Angeles Fielding School of Public Health to develop a curriculum for a climate and health workshop series for public health staff.In 2017, CalBRACE released a series of climate change and health profile reports for California’s 58 counties. These reports were developed as tools to help guide and prepare California for the health-related impacts of climate change. Funded by the CDC, the reports include background information on climate impacts, regional climate projections, the health impacts related to these projections, population vulnerabilities, and example adaptation strategies. 

As a part of CalBRACE, the CDPH developed a Climate Change and Health Vulnerability Indicators (CCHVIz) interactive data visualization platform. The indicators cover environmental exposure, population sensitivity, and adaptive capacity to climate change. The platform was developed to help stakeholders map adverse health impacts associated with climate change, allowing users to view data by county, single indicator, and vulnerability.

CalBRACE complements the CDPH’s Climate Change and Health Equity Program (CCHEP), which integrates climate change data and equity concerns in public health planning. The program focuses on the integration of climate change impacts with health and economic inequities that already exist in California’s communities. 

Additional efforts at the state level include several awareness-building tools. The State Adaptation Clearinghouse run by, which is a database of resources organized by climate impact, topic, and region. Public health is a focal topic of the Clearinghouse, which contains almost 200 documents on the topic across federal, state, and local levels. Cal-Adapt is also recommended as a resource on climate-related risks through California’s 2018 State Hazard Mitigation Plan, which details how climate change exacerbates air pollution, invasive species, droughts, vector-borne diseases, extreme heat, and severe weather.

Tribal Climate and Health Adaptation Efforts

The Blue Lake Rancheria Tribe of California has been acting on climate change for decades. In 2002, the tribe embarked on an effort to transition to zero net carbon emissions by 2030 while reducing operational costs, creating economic opportunities, and reducing air and water pollution. By 2015, the tribe had built an energy efficient hotel, completed energy efficiency upgrades throughout the community, started producing biodiesel onsite, launched a low-carbon microgrid project, and was named a Climate Action Champion by the Obama Administration. As part of these efforts, the tribe has also expanded water conservation and drought-tolerant landscaping initiatives.

The Pala Band of Mission Indians completed a climate change vulnerability assessment and adaptation plan in 2019. The adaptation planning process designed by the Pala Environmental Department (PED) as part of the national Tribal Climate Health Project is similar to the CDC BRACE framework. The Pala first identified climate-related concerns specific to human health, cultural and spiritual health, socioeconomic health, and the natural and built environment. Among the human health impacts prioritized by the tribe are heat-related illnesses, injuries and fatalities from wildfire and storms, inability to access medical services due to extreme events, disruptions in drinking water and food supplies, and vector-borne diseases. With respect to cultural and spiritual health, the tribe is concerned about potential declines in culturally-important species, loss of sacred sites or disruptions in community ceremonies, and potential dislocation or relocation. Tribal members voted on priority adaptation strategies, including providing early warning systems for extreme events; building alternative power supplies; increasing water storage capacity within the reservation; increasing public awareness campaigns; and developing emergency and health management plans. The adaptation plan builds upon these priority strategies with specific actions, implementation steps, and authorities responsible for implementation. Among the health-related actions in progress are:

  • Developing maps to identify at-risk individuals and creating a health safety plan to increase medical and community support;
  • Creating health emergency and management plans to outline procedures for pre- and post-event measures (e.g., access to services, evacuation plans, continuity of care) and onsite facilities that can serve as response centers (e.g., fire stations, faith-based organizations);
  • Establishing a referral system to ensure continuity of access to resources and services during and after climate events;
  • Conducting public campaigns to help residents avoid risks and cope with potential illnesses (e.g., food and water contamination);
  • Tracking environmental health indicators; and
  • Trained medical professionals to recognize symptoms of exposure as well as mental health impacts. 


City and County Climate and Health Adaptation Efforts

CalBRACE, in partnership with the Bay Area Regional Health Inequalities Initiative (BARHII) and the Alliance project, is working to collect data and provide recommendations on the state of climate resilience and health equity in California’s local health departments. The preliminary findings of this ongoing project include an emphasis on the lack of staff and funding across departments that are specifically dedicated to this type of work. Another major theme that resulted from the interviews conducted in this study is the need for long-term community engagement and partnerships to sustain efforts and engage local governments. The findings emphasize the importance of local health departments working within communities to improve climate resilience outcomes as they relate to public health. 

BARHII is a collaboration of eleven public health departments (e.g., Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano, and Sonoma counties, City of Berkeley) in the San Francisco Bay Area. Two of BARHII’s major areas of work include climate resilience and health equity policy. BARHII has developed a legislative policy platform for local health departments (LHDs). This template includes a section on climate change and environmental justice related to health as well as five guiding documents created to assist LHDs in understanding why and how climate change is a public health issue. BARHII collaborated with the North Bay Organizing Project  to address health and displacement concerns after four destructive wildfires in 2017, which left many residents displaced. BARHII worked with Sonoma County to develop a recovery framework that embedded equity in strategies to address displacement and housing shortages. 

Nongovernmental Climate and Health Adaptation Efforts

Tracking California is a project of the Public Health Institute, funded through state, federal, and private sources. The goal of the project is to track environmental health data to inform and improve public health efforts in the state. Some of the data being tracked includes air quality, water quality, heat-related illness, and climate change. Specifically, the climate change data tracking connects environmental and climate changes such as wildfires and sea level rise to public health impacts and related research and resources to address these concerns. The site includes information on mitigation and adaptation in an effort to prevent and prepare Californians for climate-related health impacts. 

Outcomes and Conclusions

Overall, a wide variety of efforts in California aim to address public health concerns related to climate change. Actionable steps and planning are the major foci of these efforts, but evaluation and monitoring will produce results that act as guides for current best practices regarding the integration of climate change into public health agencies.


Braddock KN, Quintana English D & Villegas A. 2020. Addressing climate adaptation in California’s public health system. [Case study on a project of the California Department of Public Health]. Product of EcoAdapt’s State of Adaptation Program. Retrieved from CAKE:… (Last updated December 2020) 

Project Contact

California Department of Public Health

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